Provider Demographics
NPI:1205834116
Name:MUIR, MOLLY M (CNM)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:MUIR
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44405 WOODWARD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5023
Mailing Address - Country:US
Mailing Address - Phone:248-858-3000
Mailing Address - Fax:
Practice Address - Street 1:1794 N LAPEER RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-7664
Practice Address - Country:US
Practice Address - Phone:810-969-4501
Practice Address - Fax:810-969-4407
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704212262367A00000X, 367A00000X
OHNM-07631367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH05225OtherPARAMOUNT
OH344428256OtherFRONTPATH
OH344428256087OtherCARESOURCE
OH000000356101OtherANTHEM
OH2528545Medicaid
OH344428256OtherBEECHSTREET
MI4638608Medicaid
MI4638617Medicaid
OH2528545Medicaid
OH75901Medicare PIN